Onychoscopic Evaluation of Inflammatory Nail Disorder and Their Relationship with Disease Duration: A Clinical Descriptive Study

Abstract

Background: Nail diseases are common problems that often exhibit diagnostic challenge for many dermatologists especially when nails are primarily affected without skin involvement. Nail dermoscopy is a simple, non-invasive tool, that became a valuable diagnostic aid for evaluating nail changes associated with various dermatological diseases. Objective: This study aimed to highlight the key onychoscopic features of major inflammatory nail diseases and correlate these findings to the duration of the disease. Patients and Method: A cross sectional clinical descriptive study was performed on 105 patients with inflammatory skin diseases and clinically evident nail changes (25 with psoriasis, 25 with dermatitis, 20 with lichen planus, 15 with connective tissue diseases, 10 with autoimmune bullous dermatoses and 10 with alopecia areata). The study was conducted from October 2021 to October 2022. Demographic variables were recorded, and nail dermoscopic findings were described using a handheld polarized dermoscopy Dermlite DL100 (10x). Then the data were collected and statistically analysed.  Results: In psoriasis, the most common onychoscopic signs were pitting (64%) and dilated capillaries at the hyponychium (64%) which showed a positive relation to early disease duration with p-value 0.05. In patients with dermatitis, the most common onychoscopic sign was dilated capillaries at the onychodermal band seen in (48%) of patients, a new dermoscopic sign; nail beading, was recorded in (24%) of patients. In patients with lichen planus, the most common sign was longitudinal ridging seen in (60%), dilated capillaries at the onychodermal band which is a newly reported sign in nail lichen planus was observed in (20%) with a significant relation to early disease duration with p-value 0.003. In Connective tissue diseases, tortuous capillaries were seen in (100%) of patients with systemic lupus erythematosus. In autoimmune bullous dermatoses, the most common signs were Beau’s lines and onychomadesis seen in (100%) of patients. In Alopecia areata patients, the most common sign was scaly cuticles seen in (80%) of patients, and no significant relation to disease duration was recognized in the studied group. Conclusion: Onychoscopy is a very useful non-invasive bedside tool for evaluating inflammatory nail disorders to reinforce the presumptive clinical diagnosis and helps to avoid invasive methods, in addition to guiding the management and prognosis of some nail disorders.